I. INTRODUCTION
For those of you spending most of your time in Pecos or beyond, you might not realize that George Bush and Texas took quite a hit from the national media as being the state that ranked 49th out of the 50 states in terms of providing adequate funding to insure that children of impoverished and economically challenged families had access to necessary medical treatment and medical insurance protection. It is the author’s observation that those statistics must have been related almost exclusively to children whose parents had not been involved in SAPCR'S, because since 1989 the Texas Family Code has contained comprehensive sections requiring insurance coverage for children and detailing provisions that must be set out in Title 5 decrees addressing insurance and medical reimbursement. Be that as it may, after George Bush's landslide victory the Texas legislature undertook a massive rewriting of Chapter 154 of the Texas Family Code to more specifically address the duties of parents and their employers with regard to medical insurance and reimbursement coverage for children. Further Chapter 32 of the Human Resources Code and Chapter 62 of the Health and Safety Code were revised to take advantage of Federal subsidies and “Tobacco” money to implement comprehensive health care for underprivileged children.
II. HISTORICAL BACKGROUND
A. Federal Law
The Federal government finally caught up with Texas when it passed the Omnibus Budget Reconciliation Act of 1993, in which Congress amended ERISA, effective August 10, 1993, to require certain child support obligors to provide medical insurance to their dependent children, by state court order. See 29 U.S.C. 1169, as well as related provisions in 42 U.S.C. 1397g-1. The legislation provided that in order to be effective and binding upon group health plan administrators, the state court order must conform to the requirements of 29 U.S.C. 1169, the requirements of which are similar to a Qualified Domestic Relations Order.
This gave the states the power to enforce upon employers the duty to protect children's health insurance benefits.
B. Texas Law
1. Family Code background
Former § 14.061, created by the 71st Legislature in 1989 first created a duty on the part of courts to require medical health insurance for children subject to SAPCR litigation effective November 1, 1989. Since that date Texas courts have habitually dealt with the requirement of child health care, and the code sections dealing with child health care have undergone extensive modification and refinement. Currently codified in § 154.181-.192 of the Texas Family Code, the code sections have required the courts since 1995 to enter a separate order, similar to a withholding order, binding on both the obligor (or, in some circumstances the obligee) and his/her employer, if such person is employed, to furnish insurance coverage to a child and appropriate access to the child’s coverage for the primary caretaker of the child.
2. Indigent children health care
a. Texas Healthy Kids Corporation - Texas Healthy Kids Corporation was a non-profit corporation created by the 75th Legislature to go into effect June 2, 1997. It was Texas' first major effort to make affordable health insurance available to uninsured Texas children. House Bill 3, passed with bipartisan support by the 75th Texas Legislature, established this corporation to administer a program through which families could purchase low-premium health insurance. Voluntary contributions from communities, businesses, and non-profit groups are also used. It was available state wide, and Texas Healthy Kids Corporation "partnered" with private insurance companies to provide coverage. Different providers served different counties. Because health care costs differed across the state, the premium rates and coverages were unrelated. Texas Healthy Kids Corporation sought private donations from individuals, corporations and foundations to help fund a sliding-scale premium, which also varied from county to county.
Because of these difficulties, and with the advent of federal legislation, and funds, and especially following the settlement of the "Big Tobacco” cases with the billions of dollars payable to Texas, the 77th Texas Legislature repealed legislation funding the Texas Healthy Kids Corporation (§ 109 of the Health and Safety Code) in favor of the CHIP program.
b. Children's Health Insurance Plan (CHIP) - Enrollment for Phase II began on April 3, 2000. Coverage began May 1, 2000. CHIP is part of Title XXI of the Social Security Act, which was signed into law by President Clinton in August 1997. CHIP makes a substantial amount of federal funding available to states for children's health insurance subsidies. In order to gain access to this funding, each state must provide matching funds and submit a proposal that meets the guidelines set forth in CHIP. The CHIP proposal for Texas involved a two-phase approach. Phase One makes all children who live in poverty through age 18 eligible for Medicaid. Phase One secured Texas's portion of the federal funding. The Texas 76th Legislature passed legislation (Senate Bill 445) setting up the framework for CHIP Phase Two and also budgeted the state funding necessary to allow Texas to receive the federal funds. CHIP is discussed at length, supra.
III. CURRENT TEXAS FAMILY CODE STATUTORY SCHEME
In 2001, the Texas Legislature had a big issue to address regarding the use to which the substantial funds derived and to be derived from the "Big Tobacco" litigation was to be utilized. It was considered by most that a large part of the moneys should be devoted to assuring that at risk and low income children in families above the poverty line would be provided medical benefits and insurance. What resulted was both a massive plan to provide coverage for these children under Chapter 62 of the Health and Safety Code and a wholesale of reworking subchapter D of Title 5 of the Texas Family Code consisting of § 154.181-.193.
A. Medical Insurance Coverage for Children
1. At Temporary Hearing
§ 154.181(a) now imposes on the trial court the affirmative duty to address insurance coverage at the initial temporary hearing, or if no temporary, at the final hearing or other “first opportunity.”
a. Notice
(1) Court must require parties to submit information by way of pleading or "other statement" regarding the children's insurance coverage.
(a) If private insurance is in place,
the pleading or statement must indicate the:
[1] identity of insurance company
[2] policy number
[3] name of parent responsible for premiums
[4] name of employer through whom coverage is afforded, and
[5] cost of premiums
(b) If no private coverage is in place the pleading or statement must state:
[1] whether the child is receiving Medicaid coverage
[2] whether the child is a CHIP or SKIP beneficiary and, if so, the cost of the premium for the child(ren)
[3] whether either parent has access to private health coverage at a "reasonable cost" defined at § 154.181(3) as not more than ten percent (10%) of the responsible parent's net income
(2) A children's medical insurance disclosure form is here attached as Attachment 1
b. If private coverage exists
Court must require the coverage to continue during the pendency of the SAPCR, absent "good cause" defined as coverage which exceeds "reasonable cost," presumptively ten percent (10%) of the responsible parent's net income [§ 154.181(e)]
c. If no private coverage exists
(1) Court must determine if child is receiving or eligible for Medicaid, CHIP or SKIP
(2) If not, court must order coverage pursuant to § 154.182 [154.181(c)] subject to the 154.181(e) “10% of net” limitation
2. At Final Hearing
The court shall require proof that:
a. private coverage exists;
b. private coverage has been applied for;
c. parent has applied for CHIP or SKIP; or
d. cost of coverage exceeds ten percent (10%) of net income
Therefore, counsel is now required to notify the court regarding coverage. If there is none, the court must inquire into efforts to secure coverage. It is seriously recommended that counsel write to his/her client well in advance of the final hearing, if the children are not covered by medical insurance, and provide the client with the TexCare Partnership web address and/or hotline number hereinafter provided so that efforts to secure coverage can be detailed for the court.
3. Duty of Court
a. In general
§ 154.182(a) requires the court to consider both (1) the cost and (2) the quality of health insurance coverage available for the children of the marriage, and sets statutory priorities for the court in ordering coverage.
b. Priorities
§ 154.182(b) requires the court to render an order based on the following priorities:
(1) Obligor's employment - If health insurance is available to the child through the obligor's employment or membership in a union, trade association, or other organization at a reasonable cost to the obligor, the court shall order the obligor to include the child in the obligor's health insurance.
(2) Obligee's employment - If health insurance is not available for the child through the obligor's employment but is available for the child at a reasonable cost through obligee's employment or membership in a union, trade association, or other organization, the court may order the obligee to provide health insurance for the child, and, in such event, shall order the obligor to pay additional child support to be withheld from earnings under Chapter 158 to the obligee for the actual cost of the health insurance for the child.
(3) Private carrier - If health insurance is not available for the child under Subdivision (1) and (2), the court shall order the obligor to provide health insurance for the child if the court finds that health insurance is available to the obligor for the child from another source and at reasonable cost.
(4) CHIP/SKIP - If neither parent has access to private health insurance at a reasonable cost, the court shall order that the custodial parent or, to the extent permitted by law, the noncustodial parent immediately apply on behalf of the child for participation in a medical assistance program under Chapter 32, Human Resources Code, or the state child health plan under Chapter 62, Health and Safety Code, and that the obligor pay additional child support, to be withheld from income under Chapter 158, to the obligee for the actual cost of participation of the child in such program; or
(5) Medical deposit - If health coverage is not available for the child under Subdivision (1), (2), (3), or (4), the court shall order the obligor to pay the obligee, in addition to any amount ordered under the guidelines for child support, a reasonable amount each month as medical support for the child to be withheld from earnings under Chapter 158. In this section, "reasonable cost" has the meaning assigned by § 154.181(e).
4. Duty of Obligor
Medical Support Orders and the Texas Family Code impose several affirmative duties on the parent/obligor regarding children’s insurance coverage once the order is in place. They consist of:
a. put in place and continue coverage § 154.181(d)
b. pay the premiums or reimburse the obligee § 154.181(a)(b)
c. pay, as additional child support, apportioned reasonable and necessary health care expenses not reimbursed by health insurance §154.181(c)
d. furnish the following information within 30 days following rendition of order:
(1) Social security number of parent
(2) Name and address of parent's employer
(3) Whether employer is self-insured or has available health insurance
(4) proof of insurance
(5) if obligor’s employer has available health insurance, obligor must provide:
(a) name of carrier
(b) policy number
(c) copy of policy and schedule of benefits
(d) health insurance membership card
(e) claim forms
(f) other necessary information for claims
(6) if obligor’s employer is self-insured, obligor must provide:
(a) schedule of benefits
(b) membership card
(c) claim forms
(d) other claim information. §154.185(a)
e. furnish additional information on insurance within 15 days of his receipt of same § 154.185(b)
f. provide notice of termination or lapse of coverage to the obligee and child support collection agency within 15 days and, notify of newly available insurance within 15 days of notice § 154.189
5. Duty of Employer
The Texas Family Code now imposes affirmative duties upon an employer subject to a Medical Support Order regarding children's medical insurance, some of which impose liability upon the employer for funds, attorney's fees, costs, and fines for failure to comply.
a. Triggered by notice
§ 154.186 provides that either the obligor, obligee, or agency (hereinafter "the sender") can provide notice of a Medical Support Order; the employer is not entitled to notice of a hearing setting the MSO.
According to § 154.187, the order becomes binding on the employer upon receipt regardless of its date of rendition.
b. Affirmative duties
(1) If the employee is eligible for immediate dependent coverage, the employer must enroll the child(ren) immediately if they are not covered and notify the sender of their status in writing within 30 days [§ 154.187(a)-(c)] regardless of payment by obligor. §154.184(b)
(2) Employer shall immediately notify its insurer of automatic enrollment. § 154.184(c)
(3) Employer shall complete all necessary forms and procedures for enrollment of child within 31 days. § 154.184(d)
(4) If dependent coverage is not immediately available to the employee, employer must notify the sender in writing within 30 days of receipt that the child(ren) cannot be enrolled and provide the reason why. § 154.187 (a)-(c)
(5) Notify the sender of termination or lapse of coverage and of available conversion privileges within 15 days of termination or lapse. §154.187(d)
(6) Provide, upon request by the sender, all necessary information regarding the available coverage, company name, policy number, policy, schedule of benefits, membership card and claim forms. § 156.187(e)
(7) Unless the employee is no longer employed, coverage is no longer available, or the policy is no longer in effect, the employer may not cancel or eliminate coverage for a child once the child is enrolled without satisfactory written evidence that the court order or administrative order is no longer in effect, or that the child is enrolled in a comparable plan. § 154.192
6. Sample Form
A sample form for decrees providing for insurance coverage is here attached as Attachment 2.
B. Enforcement of Medical Support Orders and Obligations
Enforcement of the MSO can relate both to the medical insurance coverage and to the payment of uninsured medical expenses, and can be enforced both as to the obligor and as to the employer.
1. Insurance obligation enforcement
a. Against obligor
(1) Effective garnishment
Medical support orders, once delivered to an employer, have the effect of garnishing the employee's wages for the cost of enrolled children and is enforceable under the garnishment statute. The statute requires the employer to enroll the children, if eligible, and take any additional cost from the employee's compensation. § 154.187(b)
(2) Failure to carry is contemptible
§ 154.183(a) specifically directs that an obligor's duty to pay for health insurance for the child is a child support obligation and may be enforced as such. See Kirk v. Kole, 874 S.W.2d 835 (App. 9th Dist. 1994). Punishment for contempt can consist of jail (or probation) fine, costs and fees. (§ 157 TFC)
(3) Failure to provide medical insurance coverage subjects obligor to harsh result
Newly amended § 154.188 imposes a significant additional punishment for failure to carry insurance. It reads:
"A parent ordered to provide health insurance who fails to do so is liable for:
(a) necessary medical expenses of the child, without regard to whether the expenses would have been paid if health insurance had been provided; and
(b) the cost of health insurance premiums or contributions, if any, paid on behalf of the child."
This statute was amended to add subsection (2) by the 2001 Legislature, thus clarifying that the court may require the obligor to reimburse the obligee retroactively for all the premiums the obligee has paid to discharge the obligor's responsibility by maintaining coverage to protect the children.
b. Against the employer
§ 154.187 specifically authorizes all available enforcement against the employer for violation of its duties imposed once the Medical Support Order is served that are available under writs of withholding in § 158 of the Texas Family Code. These include:
(1) liability to obligee for premium payments ordered to be withheld. § 158.206(b)(1)
(2) reasonable attorney's fees and costs. § 158.206(b)(3); and
(3) a fine for noncompliance not to exceed $200 per day. § 158.210
2. Nonreimbursed medical expenses enforcement
Tex. Fam. Code Ann. § 154.183(c) requires the court to allocate between the parties, according to their circumstances, the reasonable and necessary health care expenses of a child that are not reimbursed by health insurance. TFC § 154.183(a) provides that the amount that an obligor is required to pay for health insurance for the child may be enforced as a child-support obligation. Although section 154.183 refers to the allocation of the uninsured reasonable and necessary health-care expenses as additional child support, the statute does not specifically state that the allocation may also be enforced as a child-support obligation. Given the court's application of the Slavin test (Ex parte Slavin, 412 S.W.2d 43 (Tex. 1967)) to decree provisions for the payment of medical bills of children, great care should be taken in the drafting of such provisions. Several Texas cases have held that unpaid medical expenses properly ordered and submitted can be the subject of contempt including fines, jail or probation, costs, and attorney’s fees. See Ex parte Arnold, 926 S.W.2d (Tex.App.—Beaumont 1996), In Re Patillo, 32 S.W. 3d 907 (Tex.App.—Corpus Christi 2000), and Ex parte Walker, 2001 WL1014535 01-01-00553-CV (Tex.App.—Houston [1st Dist.] Sept. 06 2001). Additionally, this author believes that failure to pay such medical expenses determined to be due under a properly drafted order would form the basis of a child support lien pursuant to § 157.311 et seq. of the Texas Family Code. Remember also that vague provisions for the payment of future medical expenses of children that may not be enforceable by contempt may be enforced as a matter of contract or as a debt under TFC § 157.162.
IV. MEDICAL COVERAGE FOR CHILDREN OF FAMILIES OF MODEST MEANS
A. TexCare Partnership
There are currently three available resources in Texas for children of parents of modest means: Medicaid, CHIP, and SKIP. Each will be dealt with individually, but all are administered by TexCare Partnership, a state umbrella agency created to oversee this vital area of public concern. TexCare Partnership is a health insurance campaign developed especially to provide insurance coverage for Texas children ages birth to 18 years, and serves as a clearinghouse to address medical insurance coverage for all children of modest income families who don't have coverage. A simple application form is available for your clients that will access the appropriate agency and determine if the child(ren) are eligible for inclusion at:
www.texcarepartnership.com,
or a hot line is available at:
1-800-647-6558
TexCare also has offices throughout the state with community workers familiar with each program. The hot line is staffed with operators who speak English and Spanish available M-F 9 am.-9 p.m. and Saturday 9 a.m.-3 p.m. TexCare represents a great leap forward in the state's attempt to reach children of modest family incomes. The application is on line and takes about 15 minutes to complete. You must have Window '95 or later software, a printer, and Netscape 5 or Explorer 4 or later Internet browser. Eligibility is based on several factors: primarily income, but also on costs of childcare, other support obligations, disabled adult care expenses, and work related expenses.
CAVEAT: Coverage under all three programs is available if the child lives with your client regardless if he/she is a parent or stepparent, but is not available if the child does not live with the applicant.
A child living on his/her own can also apply. An applicant must provide income verification; legal residence requirements; proof of child support/alimony payments; proof of child care/adult assisted care expenses; and Social Security numbers. The Medicaid, CHIP and SKIP programs are all administered in Texas by the Texas Department of Protective and Regulatory Services.
B. Insurance Alternative for Modest Income Families
1. Medicaid
a. In general
Medicaid health insurance is provided at no cost to qualifying children.
Children's health care benefits under Medicaid are extensive and often are even better than benefits packages offered by private employers. Medicaid emphasizes preventive health care so that children's health problems can be caught early, or prevented altogether.
Once qualified for Medicaid, the child continues to receive coverage until a change occurs in the child's or the family's situation that would cause disqualification. The child's situation is checked periodically, usually once every six months, possibly more often, to determine if the child still qualifies for Medicaid coverage.
b. Qualifications
To qualify for Medicaid coverage a child must be:
(1) A Texas resident
(2) A U.S. citizen or a certain category of legal residence (this requirement may not apply in medical emergencies)
(3) Under age 19
(4) Living in a family with assets below established levels. Assets do not include the family's home or personal property; however, all or part of the value of a vehicle may count in certain situations
(5) Living in a family able to meet Medicaid income requirements. (Most types of income are counted. Deductions for work-related expenses and dependent care expenses are allowed when figuring income eligibility)
c. Medicaid Income Guidelines
|
Family Size |
Family Monthly Income
Kids 6-18 |
Family Monthly Income
Kids 1-5 Only |
Family Monthly Income
Pregnant Women & Newborns & Babies up to age 1 |
|
1 |
$716 |
$953 |
Pregnant Woman Counted as 2 |
|
2 |
$968 |
$1287 |
$1790 |
|
3 |
$1220 |
$1622 |
$2256 |
|
4 |
$1471 |
$1957 |
$2722 |
|
5 |
$1723 |
$2291 |
$3187 |
|
6 |
$1975 |
$2626 |
$3653 |
|
7 |
$2226 |
$2961 |
$4118 |
|
8 |
$2476 |
$3296 |
$4584 |
|
|
Add $252 for each additional family member |
Add $334 for each additional family member |
Add $466 for each additional family member |
Based on 2001 Federal Poverty Income Guidelines
Teen-agers' earnings can sometimes be ignored, and some childcare costs can be subtracted from earnings. TDPRS will also look at other "resources" such as money in the bank. If the family has more than one car, TDPRS will look at how much the less expensive car is worth. Owning the home one lives in, does not count against the applicant.
Information about Medicaid eligibility can be accessed at the Medicaid Section of the Texas Department of Protective and Regulatory Services website:
www.tdprs.state.tx.us
2. CHIP
a. Primary insurance
(1) Description of plan
Texas' answer to the need for low cost medical insurance was made possible by the state's settlement of the landmark case The State of Texas v. The American Tobacco Co., et al, No. 5-96CV-91 in the United States District Court for the Eastern District of Texas and under Title XXI of the Social Security Act (Title 42 U.S.C. § 1397 aa et seq.) The Texas approach was codified in Senate Bill 445 attached hereto as Attachment 3.
The Children's Health Insurance Program is designed for families who earn too much money to qualify for Medicaid health care, yet cannot afford to buy private insurance. The parents in some of these families have jobs that do not offer health insurance for children. Other parents' jobs offer health insurance, but the insurance is so expensive that families cannot afford it.
CHIP insurance is designated to solve this cost problem for many Texas families. In CHIP, many families will only pay an annual fee of $15 to cover all their children in the plan. Higher-income families will pay monthly premiums of $15 or $18, which covers all children in the family. Most families also will have co-payments for doctor visits, prescription drugs, and emergency care.
CHIP is offered by private health plans. CHIP health care coverage is comparable to that provided to families who get their insurance through employers. The CHIP benefits package has been designed specifically to meet the needs of children.
CHIP covers services such as hospital care, surgery, x-rays, therapies, prescription drugs, mental health and substance abuse treatment, emergency services, eye tests and glasses, dental care, and regular health check-ups and vaccinations.
Children who enroll in CHIP receive 12 months of continuous coverage. Families must re-enroll their children once a year.
(2) Eligibility
To qualify for CHIP a child must be:
a. A Texas resident
b. A U.S. citizen or legal permanent resident (the citizenship or immigration status of the parents does not affect the child(ren)'s eligibility and is not reported on the application form)
c. Under age 19
* d. Be uninsured for at least 90 days (although there are several exceptions to this requirement)
e. Living in a family that meets CHIP Income Requirements
* (3) Good cause exceptions to 90-day rule:
Five exceptions to the rule requiring a 90-day uninsured period preceding eligibility exist. They are:
a. Termination of a parent's employment
b. COBRA coverage ended
c. Change in marital status of a parent
d. Cost of a child's health insurance is greater than 10 percent of the family's net income.
e. Loss of Medicaid coverage
(4) Income requirements
Income requirements determine eligibility and depend, according to Federal law, upon the age of the child. Generally speaking the following are the basic income requirements for eligibility:
| Age of Child |
Federal Poverty Level |
Family Size |
Family Income |
|
Under 12 months |
185
through
200
percent |
1 |
$1,325 through $1,432 |
|
|
|
2 |
$1,790 through $1,935 |
|
|
|
3 |
$2,256 through $2,439 |
|
|
|
4 |
$2,722 through $2,942 |
|
|
|
5 |
$3,187 through $3,445 |
|
|
|
|
|
|
Age 12 months through 5 years |
133
through
200
percent |
1 |
$953 through $1,432 |
|
|
|
2 |
$1,287 through $1,935 |
|
|
|
3 |
$1,622 through |
|
|
|
4 |
$1,957 through $2,942 |
|
|
|
5 |
$2,291 through $3,455 |
|
|
|
|
|
| Age 6 through
end of month
of 19th birthday |
100
through
200
percent |
1 |
$716 through $1,432 |
|
|
|
2 |
$968 through $1,935 |
|
|
|
3 |
$1,220 through $2,439 |
|
|
|
4 |
$1,471 through $2,942 |
|
|
|
5 |
$1,723 through $3,445 |
Based on Year 2001 Federal Poverty Income Guidelines
If a family income is below these limits, there's a good chance children will be eligible for CHIP. Income can be even higher and a child may still qualify for CHIP if:
a. There are childcare expenses
b. The family pays for the care of a disabled adult
c. The family pays alimony or child support
d. The family has eligible work-related expenses
CHIP is essentially an HMO network within each county. Attached to this paper, as Attachment 4 is a list of the current providers by county. Check your county for availability of coverage.
Also attached, as Attachment 5 and 6 are the annual fee and premiums breakdown for CHIP coverage. The CHIP program has been successful beyond the imagination of the Texas health and Human Services Commission as demonstrated by the numbers of contacts, enrollees, and potential enrollees. As of February 18, 2002 just short of one million contacts have been made. A breakdown of the numbers as of that date is here attached as Attachment 7.
b. CHIP dental benefits
The CHIP dental benefit gives CHIP-eligible children access to preventive and therapeutic dental care. The goal is to keep children health through regular dental check-ups.
CHIP dental benefits include:
· Routine teeth cleanings
· X-rays
· Dental check-ups
· Sealants
· Fillings
· Root canals
· Crowns
· Extractions (tooth removal)
Only dental procedures listed in the CHIP Schedule of Dental Services will be covered by CHIP. Children must visit a CHIP network dentist in order to receive benefits under CHIP.
There is a dollar limit on CHIP preventive dental benefits linked to the 12-month enrollment period: $172 for preventive services for children ages one through 12, and $181 for children 13 through 18. One preventive dental visit per enrollment year per child is covered by CHIP.
CHIP therapeutic dental treatment is also capped at $300 per enrollment year. Thus, the total yearly cap on preventive and therapeutic dental care is $472 for children age 13 and younger, and $481 for children older than 13.
CHIP families will be responsible for paying dental costs they incur over and above these yearly maximum cost limits. Some allowable dental procedures, such as some crowns and root canals, can cost more than $300. CHIP will pay up to the limit for these procedures, then families must pay their dentist the balance of the CHIP-allowed fee.
"Frequency limits" are set on some dental procedures, meaning that the procedures can only be done as often as the benefit plan specifies. For example, CHIP will pay for children having their teeth cleaned only once a year. If a child has his or her teeth cleaned a second time during the year, their family will have to pay for the second cleaning.
Any child enrolled in CHIP is automatically enrolled in the CHIP dental services program and will receive a dental services ID card, a certificate of coverage, and a dental provider directory.
The CHIP dental plan is administered statewide by one provider, United Concordia with a Texas office in Plano, Texas. The company can be reached at 1-800-332-0366 for inquiries.
3. SKIP
a. In general
The State Kids Insurance Program (SKIP) was created in 1999 to ensure that all children of state and higher education employees have access to more affordable health care. Thanks to legislation passed in 2001, the program is now better than ever.
Beginning in September 2001, the State has increased all SKIP supplements to pay most of the health insurance premiums of eligible children. Depending on family size and income (see chart below), some will pay only a $15 annual enrollment fee and others will pay only $15 per month towards the premiums for their eligible children. Many employees with dependent children may qualify with the new income guidelines.
SKIP mirrors the federal Children's Health Insurance Program (CHIP). A state employee is not eligible for CHIP; but benefits will be similar with the SKIP supplement.
The supplement will pay for premiums for children currently covered by insurance. If SKIP-eligible children are not currently on a health plan, they will be added automatically once approved for the program.
b. Criterion for SKIP
The SKIP supplement is available if the employee:
(1) Has children eligible for state insurance under the age of 19 living with the employee in Texas;
(2) Meets eligibility criteria according to family income and size;
(3) Not eligible for Medicaid; and
(4) Is a U.S. citizen or legal resident.
4. SKIP income eligibility
A similar income breakdown is in place for state and higher education employees as in CHIP. The eligibility is as follows:
| Family
Size* |
Yearly Gross
Income |
Monthly Gross
Income |
|
2 |
$23,220 |
$1,935 |
|
3 |
$29,260 |
$2,439 |
|
4 |
$35,300 |
$2,942 |
|
5 |
$41,340 |
$3,445 |
|
6 |
$47,380 |
$3,949 |
|
7 |
$53,420 |
$4,452 |
|
8 |
$59,460 |
$4,955 |
|
*Add $5,800 to the Yearly Gross Income for each additional family member |
A third-party administrator, Birch & Davis through the TexCare Partnership program, determines eligibility for the SKIP program.
V. CONCLUSION
Texas is in the forefront of efforts to insure that children are adequately covered by legislation and court authority insuring medical coverage for children to the extent possible. It is hoped that this paper will give some insight to practitioners so as to do our part in protecting children's needs for medical coverage when we are involved in marital dissolution.